Hepatitis B is a serious disease caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.

Hepatitis B vaccine is available for all age groups to prevent hepatitis B virus infection.

More resources can be found at the following links:

• CDC en Español
• CDC Publications (MMWR recommendations and surveillance guidelines)
• Correctional Settings
• Educational Materials
• Fact Sheet
• Frequently Asked Questions
• Hemodialysis Guidelines
• Hepatitis B Coordinators
• Illegal Injection Drug Use
• Integrating Hepatitis B Vaccination into STD and HIV/AIDS Programs
• Links
• Post-exposure Prophylaxis Guidelines for Healthcare Workers
• Serology
• Sexually Transmitted Diseases Treatment Guidelines
• Vaccine
• Vaccine Schedules
  • Interrupted schedules
    
     

CDC is not a treatment facility. If you are looking for information about treatment for hepatitis B, visit the following websites: AASLD Update of Chronic Hepatitis B Recommendations AASLD Practice Guidelines PubMed Article on Adefovir dipivoxil treatment (e antigen-positive) PubMed Article on Adefovir dipivoxil treatment (e antigen-negative) FDA article on entecavir Information from the National Institutes of Health (NIH)

General Information

What is hepatitis B?
Hepatitis B is caused by a virus that attacks the liver. The virus, which is called hepatitis B virus (HBV), can cause lifelong infection, cirrhosis (scarring) of the liver, liver cancer, liver failure, and death.

How do you know if you have hepatitis B?
Only a blood test can tell for sure.

How is HBV spread?
HBV is spread when blood or body fluids from an infected person enters the body of a person who is not infected. For example, HBV is spread through having sex with an infected person without using a condom (the efficacy of latex condoms in preventing infection with HBV is unknown, but their proper use might reduce transmission), by sharing drugs, needles, or "works" when "shooting" drugs, through needlesticks or sharps exposures on the job, or from an infected mother to her baby during birth.

Hepatitis B is not spread through food or water, sharing eating utensils, breastfeeding, hugging, kissing, coughing, sneezing or by casual contact.

How long does it take for a blood test, such as HBsAg, to be positive after exposure to hepatitis B virus?
HBsAg will be detected in an infected person’s blood on the average of 4 weeks (range 1-9 weeks) after exposure to the virus. About 1 out of 2 patients will no longer be infectious by 7 weeks after onset of symptoms and all patients, who do not remain chronically infected, will be HBsAg-negative by 15 weeks after onset of symptoms.

If a person has symptoms, how long does it take for symptoms to occur after exposure to hepatitis B virus?
If symptoms occur, they occur on the average of 12 weeks (range 9-21 weeks) after exposure to hepatitis B virus. Symptoms occur in about 70% of patients. Symptoms are more likely to occur in adults than in children.

What are the symptoms of hepatitis B?
Sometimes a person with HBV infection has no symptoms at all. The older you are, the more apt you are to have symptoms. You might be infected with HBV (and be spreading the virus) and not know it.

If you have symptoms, they might include:

• yellow skin or yellowing of the whites of your eyes (jaundice)
• tiredness
• loss of appetite
• nausea
• abdominal discomfort
• dark urine
• clay-colored bowel movements
• joint pain

What are the risk factors for hepatitis B?
You are at increased risk of HBV infection if you:

• have sex with someone infected with HBV
• have sex with more than one partner
• shoot drugs
• are a man and have sex with a man
• live in the same house with someone who has chronic (long-term) HBV infection
• have a job that involves contact with human blood
• are a client in a home for the developmentally disabled
• have hemophilia
• travel to areas where hepatitis B is common (view map)

One out of 20 people in the United States will get infected with HBV some time during their lives.

Your risk is higher if your parents were born in Southeast Asia, Africa, the Amazon Basin in South America, the Pacific Islands, or the Middle East.

Is there a cure for hepatitis B?
There are no medications available for recently acquired (acute) HBV infection. Hepatitis B vaccine is available for the prevention of HBV infection. There are antiviral drugs available for the treatment of chronic HBV infection.

How common is HBV infection in the U.S.?
In 2003, an estimated 73,000 people were infected with HBV. People of all ages get hepatitis B and about 5,000 die per year of sickness caused by HBV.

If you are pregnant, should you worry about hepatitis B?
Yes, you should get a blood test to check for HBV infection early in your pregnancy. This test is called hepatitis B surface antigen (HBsAg). If you test HBsAg-negative early in pregnancy, but continue behaviors that put you at risk for HBV infection (e.g., multiple sex partners, injection drug use), you should be retested for HBsAg close to delivery. If your HBsAg test is positive, this means you are infected with HBV and can give the virus to your baby. Babies who get HBV at birth might develop chronic HBV infection that can lead to cirrhosis of the liver or liver cancer.

If your blood test is positive, your baby should receive the first dose of hepatitis B vaccine, along with another shot, hepatitis B immune globulin (called HBIG), at birth. The second dose of vaccine should be given at aged 1-2 months and the third dose at aged 6 months (but not before aged 24 weeks).

Can I donate blood if I have had any type of viral hepatitis?
If you had any type of viral hepatitis since aged 11 years, you are not eligible to donate blood. In addition, if you ever tested positive for hepatitis B or hepatitis C, at any age, you are not eligible to donate, even if you were never sick or jaundiced from the infection.

How long can HBV survive outside the body?
HBV can survive outside the body at least 7 days and still be capable of causing infection.
 

Hepatitis B Vaccine Information

Who should get vaccinated?

• All babies, at birth
• All children 0-18 years of age who have not been vaccinated
• People of any age whose behavior or job puts them at high risk for HBV infection (see risk factors under general information)

What are the dosages and schedules for hepatitis B vaccines?
The vaccination schedule most often used for adults and children has been three intramuscular injections, the second and third administered 1 and 6 months after the first. Recombivax HB® has been approved as a two dose schedule for aged 11-15 years. Engerix-B® has also been approved as a four dose accelerated schedule.

Read more about hepatitis A and hepatitis B vaccine schedules (*external link)

Can you receive one dose of hepatitis B vaccine from one manufacturer and the other doses from another manufacturer?
Yes. The immune response when one or two doses of a vaccine produced by one manufacturer are followed by subsequent doses from a different manufacturer has been shown to be comparable with that resulting from a full course of vaccination from one manufacturer.

What should be done if there is an interruption between doses of hepatitis B vaccine?
If the vaccination series is interrupted after the first dose, the second dose should be administered as soon as possible. The second and third doses should be separated by an interval of at least 2 months. If only the third dose is delayed, it should be administered when convenient.

Can other vaccines be given at the same time that hepatitis B vaccine is given?
Yes. When hepatitis B vaccine has been administered at the same time as other vaccines, no interference with the antibody response of the other vaccines has been demonstrated.

Are hepatitis B vaccines safe?
Yes. Hepatitis B vaccines have been shown to be safe when administered to both adults and children. Over 4 million adults have been vaccinated in the U.S., and at least that many children have received hepatitis B vaccine worldwide.

How long does hepatitis B vaccine protect you?
Long-term studies of healthy adults and children, who have developed adequate antibody to hepatitis B surface antigen (anti-HBs), indicate that immunologic memory remains intact for at least 15 years and confers protection against clinical illness and chronic HBV infection, even though anti-HBs levels might become low or decline below detectable levels.

Can hepatitis B vaccine be given after exposure to HBV?
Yes. After a person has been exposed to HBV, appropriate treatment, given in an appropriate time frame, can effectively prevent infection. The mainstay of post exposure immunoprophylaxis is hepatitis B vaccine, but in some settings the addition of HBIG will provide some increase in protection.

Should pre-vaccination testing be done?
Pre-vaccination testing is not routinely recommended. The decision to do pre-vaccination testing is usually based on cost. To avoid vaccinating persons who have already had or have HBV infection, testing for prior infection should be considered for adults in risk groups with high rates of HBV infection (e.g., injecting drug users, men who have sex with men and household contacts of persons with chronic HBV infection).

Pre-vaccination testing is not indicated for immunization programs for children or adolescents because of the low rate of HBV infection and the relatively low cost of vaccine.

Who should get post-vaccination testing?
Testing for immunity is advised only for persons whose subsequent clinical management depends on knowledge of their immune status (e.g., infants born to HBsAg-positive mothers, immune compromised persons, healthcare workers, and sex partners of persons with chronic HBV infection).

When should post-vaccination testing be done?
When necessary, post-vaccination testing, using the anti-HBs test, should be performed 1 to 2 months after completion of the vaccine series – EXCEPT for post-vaccination testing of infants born to HBsAg-positive mothers. Testing of these infants should be performed 3 to 9 months after the completion of the vaccination series

* Read the Post Exposure Prophylaxis MMWR {Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Post-exposure Prophylaxis}

For how long is hepatitis B vaccine effective?
Long-term studies of healthy adults and children indicate that hepatitis B vaccine protects against chronic HBV infection for at least 15 years, even though antibody levels might decline below detectable levels.

Are booster doses of hepatitis B vaccine needed routinely?
No, booster doses of hepatitis B vaccine are not recommended routinely for persons who are not immune compromised. Data show that vaccine-induced anti-HBs levels might decline over time; however, immune memory remains intact indefinitely following immunization. Immune competent people with declining antibody levels are still protected against clinical illness and chronic disease.

Can hepatitis B vaccine be given during pregnancy or when breastfeeding?
Yes, neither pregnancy nor breastfeeding should be considered a contraindication to vaccination of women. On the basis of limited experience, there is no apparent risk of adverse effects to developing fetuses when hepatitis B vaccine is administered to pregnant women. The vaccine contains noninfectious HBsAg particles and should cause no risk to the fetus. HBV infection affecting a pregnant woman might result in severe disease for the mother and chronic HBV infection for the newborn.

Can hepatitis B vaccine be given to immune compromised people?
(e.g., people on hemodialysis or people with AIDS)
Yes, however larger vaccine doses or an increased number of doses are required to induce protective antibody in a high proportion of hemodialysis patients and might also be necessary for other immune compromised people (e.g., those who take immunosuppressive drugs or who have AIDS). For immune compromised people, it is important that post vaccination testing, using the anti-HBs test, be done 1-2 months after the last dose of vaccine to check that the vaccine worked. In addition, immune compromised people need periodic testing and possibly booster doses of hepatitis B vaccine to assure that anti-HBs is still adequate.
 

What is the rationale for recommending the hepatitis B
vaccination of children and other groups mentioned above?

Rationale for Hepatitis B Immunization Strategies in the United States

• Read more facts about hepatitis B vaccine
   

If You Are Living With Chronic Hepatitis B

What does the term "chronic hepatitis B" mean?
Chronic infection with HBV means that you have a long-term HBV infection; your body did not get rid of the virus when you were first infected with HBV. Two percent to 6% of people over aged 5 years; 30% of children aged 1-5 years; and up to 90% of infants develop chronic infection. People with chronic infection can infect others and are at increased risk of serious liver disease including cirrhosis and liver cancer. In the United States, an estimated 1.25 million people are chronically infected with HBV.

What is the treatment for chronic hepatitis B?
There are three drugs licensed for the treatment of people with chronic hepatitis B: Adefovir dipivoxil, alpha interferon, lamivudine, and entecavir. These drugs work in up to 40% of people.
 

Traveler’s Health Information

What is the risk of getting HBV infection while traveling in other countries?
The risk of HBV infection for international travelers is generally low, except for certain travelers in countries where the prevalence of chronic HBV infection is high or intermediate (see map).

Factors to consider in assessing risk include 1) the prevalence of chronic HBV infection in the local population, 2) the extent of direct contact with blood or other body fluids or of sex contact with potentially infected people, and 3) the duration of travel.

Modes of HBV transmission in areas with high or intermediate prevalence of chronic HBV infection that are important for travelers to consider are contaminated injection and other equipment used for health care-related procedures and blood transfusions from unscreened donors. However, unprotected sex and sharing illegal drug injection equipment are also risks for HBV infection in these areas.

World Map of Hepatitis B surface antigen (HBsAg) Prevalence, 2002

1. high (8% or more) in
   • Alaska and extreme northern Canada and southern Greenland;
   • a band crossing South America, including northern Chile, southern Colombia, extreme southern Venezuela, northwestern Brazil and northern Bolivia;
   • parts of Eastern Europe, including Moldova, Bulgaria, Georgia, Armenia, and Azerbaijan
   • all of Africa except northern Morocco, Algeria, Tunisia, Libya, and Egypt;
   • Saudi Arabia, Lebanon, Israel, and Jordan;
   • Turkmenistan, Uzbekistan, Kazakhstan, Kyrgyzstan, Tajikistan, Mongolia;
   • South Asia and Southeast Asia.
2. intermediate (2% to 7%) in
   • parts of Central America, including Guatemala, El Salvador, Honduras, Haiti and the Dominican Republic;
   • parts of South America, including northern Venezuela, Guyana and Suriname, and central and southern Brazil;
   • northern Africa, including northern Morocco, Algeria, Tunisia, Libya, and Egypt;
   • the Middle East except Saudi Arabia, Lebanon, Israel, and Jordan;
   • southern sections of Eastern Europe except Moldova, Bulgaria, Georgia, Armenia, and Azerbaijan; and Poland;
   • portions of Western Europe including Italy, Sardinia, Spain, Portugal;
   • Russia;
   • Japan.
3. low (under 2%) in all areas not already listed

• Read more about hepatitis B when traveling

Serology

How do I interpret serological lab results?

What do the different abbreviations on the lab results mean?

• Hepatitis B Surface Antigen (HBsAg): A serologic marker on the surface of HBV. It can be detected in high levels in serum during acute or chronic hepatitis. The presence of HBsAg indicates that the person is infectious. The body normally produces antibodies to HBsAg as part of the normal immune response to infection.
• Hepatitis B Surface Antibody (anti-HBs): The presence of anti-HBs is generally interpreted as indicating recovery and immunity from HBV infection. Anti-HBs also develops in a person who has been successfully vaccinated against hepatitis B.
• Total Hepatitis B Core Antibody (anti-HBc): Appears at the onset of symptoms in acute hepatitis B and persists for life. The presence of anti-HBc indicates previous or ongoing infection with hepatitis B virus (HBV) in an undefined time frame.
• Hepatitis B e Antigen (HBeAg): A secreted product of the nucleocapsid gene of HBV and is found in serum during acute and chronic hepatitis B. Its presence indicates that the virus is replicating and the infected individual has high levels of HBV.
• Hepatitis B e Antibody (HBeAb or anti-HBe): produced by the immune system temporarily during acute HBV infection or consistently during or after a burst in viral replication. Spontaneous conversion from e antigen to e antibody (a change known as seroconversion) is a predictor of long-term clearance of HBV in patients undergoing antiviral therapy and indicates lower levels of HBV.
• Hepatitis B Immune Globulin (HBIG): A product available for prophylaxis against HBV infection. HBIG is prepared from plasma containing high titers of anti-HBs and provides short-term protection (3 - 6 months).
• IgM Antibody to Hepatits B Core Antigen (IgM anti-HBc): Positivity indicates recent infection with HBV (≤6 mos). Its presence indicates acute infection.

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